结直肠癌患者外周血生存素检测的临床意义

Detection of serum survivin in colorectal carcinoma patients and its clinical significance

目的采用实时定量逆转录-聚合酶链反应(RT-PGR)技术,检测结直肠癌患者外周血中生存素基因的表达,并分析其与转移之间的关系,探讨其成为无创性结直肠癌诊断、转移检测指标的可能性。方法取58例结直肠癌患者,46例非癌性肠道病变患者和29名健康成人的外周血,用实时定量RT-PCR的方法检测Survivin基因的表达,分析其与临床病理因素之间的关系。结果正常对照组外周血中未检测到Survivin mRNA表达转录本。癌前病变患者生存素表达检测率为6.25%,平均拷贝数为1.77±0.75;肠癌组患者生存素表达检测率为79.3%,平均拷贝数为5.62±1.32,两者差异有统计学意义(P<0.01)。Survivin的表达在各性别、年龄、及不同分化组之间差异无统计学意义,而有、无淋巴结转移组之间以及Dukes分期C、D组与A、B组之间则发现Survivin的表达显著增高(P<0.05)。生存分析表明,Survivin mRNA的高表达者4年生存率(62.9%)显著低于低表达者(86.6%)(P<0.05)。回归分析发现,Dukes分期为影响肠癌预后有的独立因素。结论生存素基因在结肠癌患者中存在过表达,并可能与转移有关,采用实时定量RT-PGR检测外周血中生存素基因的表达,可能成为一种较理想的无创性结肠癌诊断、转移检测方法。

Objective To analyze the feasibility of amplifying survivin gene by real-time quantitative reverse transcriptase polymerase chain reaction （RT-PCR） in diagnosis and metastas is detection of colorectal carcinoma. Methods RT-PCR was used to detect the peripheral blood carcinoma gene in normsal adults, patients with non-cancerous lesions and with colorectal carcinoma （metastased group and non-metastased group）. To evaluate the correlation between gene expression and metastasis in colorectal carcinoma. Results In the specimens of normal adults, patients with noncancerous lesions and with colorectal carcinoma, the expression rates of survivin mRNA were 0% , 6.25% and 79.3%. The expression of survivin was statistically associated with lymph node involvement and Dukes stage. Four-year survival rate was lower in patients with higher expression rates. Cox stepwise proportional hazards analysis showed that dukes stage retained significant independently in prospecting prognosis. Conclusions Survivin gene was overexpressed in colorectal cancer. It may be also an important marker of matastasis. RT-PCR can be used to detect metastases of colorectal cancer in early stage.